Abstract
BackgroundPatients seek care from physical therapists for neck pain but it is unclear what the association of the timing of physical therapy (PT) consultation is on 1-year healthcare utilization and costs. The purpose of this study was to compare the 1-year healthcare utilization and costs between three PT timing groups: patients who consulted a physical therapist (PT) for neck pain within 14 days (early PT consultation), between 15 and 90 days (delayed PT consultation) or between 91 and 364 days (late PT consultation).MethodsA retrospective cohort of 308 patients (69.2% female, ages 48.7[±14.5] years) were categorized into PT timing groups. Descriptive statistics were calculated for each group. In adjusted regression models, 1-year healthcare utilization of injections, imaging, opioids and costs were compared between groups.ResultsCompared to early PT consultation, the odds of receiving an opioid prescription (aOR = 2.79, 95%CI: 1.35–5.79), spinal injection (aOR = 4.36, 95%CI:2.26–8.45), undergoing an MRI (aOR = 4.68, 95%CI:2.25–9.74), X-ray (aOR = 2.97, 95%CI:1.61–5.47) or CT scan (aOR = 3.36, 95%CI: 1.14–9.97) were increased in patients in the late PT consultation group. Similar increases in risk were found in the delayed group (except CT and Opioids). Compared to the early PT consultation group, mean costs were $2172 ($557, $3786) higher in the late PT contact group and $1063 (95%CI: $ 138 - $1988) higher in the delayed PT consultation group.DiscussionThere was an association with the timing of physical therapy consultation on healthcare utilization and costs, where later consultation was associated with increases costs and healthcare utilization. This study examined the association of timing of physical therapy consultation on costs and healthcare utilization, but not the association of increased access to physical therapy consultation. Therefore, the findings warrant further investigation to explore the effects of increased access to physical therapy consultation on healthcare utilization and costs in a prospective study.
Highlights
Patients seek care from physical therapists for neck pain but it is unclear what the association of the timing of physical therapy (PT) consultation is on 1-year healthcare utilization and costs
Twenty-four percent (n = 74) of patients consulted within 15–90 days (“delayed physical therapy consultation”) and 24% (n = 74) of patients consulted a physical therapist between 91 days and 364 days after the index visit (“late physical therapy consultation”)
We found that consulting a physical therapist late after seeking care for a new episode of neck pain was associated with increased healthcare utilization including spinal injections, imaging (X-ray, Magnetic resonance imaging (MRI) and Computed tomography (CT) scan) and opioid prescription within 1-year following the index visit
Summary
Patients seek care from physical therapists for neck pain but it is unclear what the association of the timing of physical therapy (PT) consultation is on 1-year healthcare utilization and costs. The improvement in cost savings and decreased healthcare utilization associated with early physical therapy consultation are thought to be attributed to quicker initiation of physical therapy using appropriate interventions [18] and decreasing exposure to unneeded diagnostic testing, interventions and high-risk pain management strategies such as prescribing opioids [19,20,21,22,23,24]. These findings indicate that physical therapists may be an appropriate front line provider for patients to consult early during an episode of neck pain [25]
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